Plus-Hex CLINICAL equipment has been handed out , as this allows time for the patient to settle , anaesthetic monitoring equipment to be attached and the surgeon to ensure all the required equipment is available .
The use of an SSC complies with the RCVS Practice Standards Scheme ( PSS ) as evidence that the patient ' s details have been confirmed by all present in the theatre [ 10 ] . All parties involved should stop what they are doing and provide relevant information for the SSC , as the patient ' s safety is the responsibility of all those involved in its care [ 11 ] . Questions such as ‘ Have the patient details been confirmed ?’ and ‘ Are there any patient-specific concerns ?’ are examples of questions at this stage .
Pre-recovery stage
The pre-recovery check should be completed at the end of the procedure but before the patient is woken from anaesthesia . This allows time to ensure all procedures have been completed , a full swab and sharp count has been performed and a recovery plan is in place . Ideally , again , this stage is completed by all staff involved with the patient to ensure consistency and accuracy .
Suggestions of additional features that could be included in an SSC include :
• required clip margins
• theatre set-up
• patient positioning
• estimated severity of blood loss ( low , moderate , high )
• anticipated duration of the procedure
• any additional procedures to be performed .
How to create an SSC
Free SSC templates are available , so the creation of a new checklist from scratch is unnecessary and likely to be time-consuming . The Association of Veterinary Anaesthetists ( AVA ) has developed a free anaesthetic safety checklist that can be downloaded , used and adapted by all veterinary professionals [ 12 ] ( Appendix 1 ). The RCVS Knowledge website also provides a range of SSCs in the Surgical Safety Checklist Manual [ 13 ] , such as the example in Appendix 2 . These could be used in their current form or could provide inspiration for a bespoke SSC . Although these free templates are available for use , ideally an SSC should be customised to meet the needs of the individual practice [ 13 ] .
A willingness to adapt and change an SSC to suit the needs of the team members using it is key to a collaborative and compliant approach .
Silver-MacMahon [ 8 ] recommends appointing a ‘ checklist champion ’ who oversees the development , use of and compliance with the SSC within the practice . This can be any member of staff with a keen interest in and knowledge of the checklist .
Communication and compliance
Compliance can be defined as the act of ‘ adhering to or conforming with law , rules , demand or request ’ [ 14 ] . In life we are continuously complying with the law , so the requirements of compliance are not new to us . Where consequences are deemed minimal , compliance is reduced , and this may be seen with the introduction of SSCs in practice . Awareness of the importance of SSCs and implementing their use is likely to promote compliance , especially if a practice audit has identified a trend in morbidity and mortality rates .
The use of SSCs encourages multimodal communication techniques , which are thought to reduce breakdowns in communication and therefore enhance success [ 15 ] . The main methods of communication when using an SSC are verbal , when asking questions to obtain the relevant and required information , and written , when completing the checklist itself . Written evidence can be revisited to refresh team members ' memory and limit mistakes . The SSC consists of closed questions , which allow ‘ yes ’ or ‘ no ’ responses , alongside some open questions that require further detail . This mixture of questioning techniques allows quick responses to be given where appropriate , with a tick or circle box used to reduce time . If further information is required , it can be briefly noted on the checklist .
Completion of additional paperwork in the perianaesthetic period may seem arduous and unnecessary ; however , this should not be a reason to compromise patient safety . It is thought that the main barriers to compliance with and completion of SCCs are time , complexity and forgetfulness [ 4 ] . It is essential that all members of staff , including veterinary surgeons ( VSs ), engage with the checklist . While some team members might feel it adds time to the surgical procedure , planning for potential risks will improve patient safety and reduce the incidence of errors [ 16 ] . It has also been suggested that the use of SSCs may not be fostered if the lead VS does not see their value [ 17 ] . Although the process may initially appear to be time-consuming , overall , it is likely that time will be saved with the use of an SSC as it helps to ensure correct surgical preparation .
On review of the available SSC templates , it will be clear that the time required to complete the form is likely to be minimal . The layout of an SSC is simple and therefore should not deter busy veterinary professionals from its use . Again , the checklist can and should be modified to suit its individual use , which means that its complexity or simplicity can be altered . However , compliance is most likely to be maintained if the checklist is easy to use , with
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